Annals for Educators - October 2022
Authors: Christine Laine
Journal: Annals of Internal Medicine (2022)

Web ExclusivesOctober 2022Annals for Educators - October 2022FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202210180 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsEffectiveness of an Unsupervised Online Yoga Program on Pain and Function in People With Knee Osteoarthritis. A Randomized Clinical TrialThis randomized trial evaluated the effectiveness of yoga among adults with symptomatic knee osteoarthritis. The investigators assessed changes in knee pain during walking, physical function, and other outcomes over 12 weeks among adults who received online osteoarthritis information plus access to an unsupervised online yoga program versus information alone.Use this article to:Review pharmacologic and nonpharmacologic interventions that have been shown to improve pain and function in persons with knee osteoarthritis.Use the CONSORT recommendations to guide a discussion of the quality of the reporting of this randomized clinical trial.Invite a yoga instructor to your session, and learn some poses as a group.Ask your learners whether they would recommend online yoga for their patients with new osteoarthritis. Based on this trial, what factors might be helpful in identifying patients who would benefit?Early Rhythm Control Therapy for Atrial Fibrillation in Low-Risk Patients. A Nationwide Propensity Score–Weighted StudyRhythm control has been shown to be associated with lower risk for adverse cardiovascular outcomes versus usual care for many patients with atrial fibrillation and high risk for stroke. This study examined whether patients with low risk for stroke might also benefit from rhythm control.Use this article to:Review the CHA2DS2-VASc score for assessing stroke risk in patients with atrial fibrillation.Invite a cardiologist to your session to discuss the various options for rate and rhythm control, as well as factors to consider when deciding which therapeutic option is most appropriate for a particular patient.Prevalence and Characteristics of Adrenal Tumors in an Unselected Screening Population. A Cross-Sectional StudyAdrenal Incidentalomas: Insights Into PrevalenceGuidelines recommend that 1-cm or larger adrenal tumors without clinical indications of adrenal disease be assessed for possible cancer and hormone secretion. Most of these tumors are found incidentally in patients having imaging studies for other reasons. This study measured the prevalence of such tumors in patients having routine health examinations. The accompanying editorial discusses insights the findings offer into the prevalence of adrenal tumors and gaps to address in future studies.Use this article and the editorial to:Invite an endocrinologist to your session, and review the work-up of an incidental adrenal mass.Discuss clinical features that raise concern that an incidental adrenal mass is malignant.Invite a radiologist to your session to review imaging studies that revealed incidental adrenal masses, and discuss whether features on imaging indicate a likely cancer.Maternal, Infant, and Child Health Outcomes Associated With the Special Supplemental Nutrition Program for Women, Infants, and Children. A Systematic ReviewThe U.S. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides supplemental foods, nutrition education and breastfeeding support, screening and referrals to medical and social services, and support for eligible low-income women and children younger than 5 years. This review describes evidence on the association of maternal, infant, and child health outcomes with WIC participation.Use this article to:Watch the brief video summarizing the results of the review. Discuss the strengths and weaknesses of available evidence on the effectiveness of this program.Review a current ACP policy paper on food insecurity. Role-play clinical conversations to address food insecurity during inpatient and outpatient encounters.Invite a social worker to your session to review how to refer a patient to WIC and other programs that can assist patients with food insecurity.Current Clinical Challenges in the Prevention and Management of COVID-19This article summarizes the 7 September 2022 Annals/ACP COVID-19 Forum. The program featured a moderated discussion among 4 infectious disease specialists who discussed their approaches to common clinical scenarios and answered audience questions.Use this article to:Watch the video of the forum with your learners, stopping after each clinical scenario to poll them about what they would do in that situation.Review the indications for and appropriate timing of the bivalent COVID-19 vaccines.Review the indications for COVID-19 treatment with Paxlovid and the procedures at your institution for prescribing it.Review the indications for COVID-19 prophylaxis with Evusheld and the procedures at your institution for prescribing it.Beyond the GuidelinesHow Would You Screen This Patient for Colorectal Cancer? Grand Rounds Discussion From Beth Israel Deaconess Medical CenterCurrent guidelines for colorectal cancer screening recommend starting it at age 45 years rather than the previous threshold of 50 years. In this article, a primary care physician and a gastroenterologist discuss the age recommendation and the merits of various screening options and how to choose among them.Use this article to:Watch the patient video with your learners, and then ask them whether they would recommend colorectal cancer screening for the patient.Review the potential benefits and harms of beginning screening at younger ages.Review patient characteristics other than age that should prompt consideration of screening before age 50.Have your learners test their knowledge by completing the quiz that accompanies the article.Alcohol UseUnhealthy alcohol use—the consumption of alcohol above a level that has caused or has the potential to cause physical, psychological, or social consequences—is common, underrecognized, and undertreated. For example, data from the 2020 National Survey on Drug Use and Health indicate that 7.0% of adults reported heavy alcohol use in the previous month, and only 4.2% of adults with alcohol use disorder received treatment. Primary care is an important setting for optimizing screening and treatment of unhealthy alcohol use to promote individual and public health.Use this article to:Discuss the criteria for the diagnosis of alcohol use disorder.Role-play conversations with patients about decreasing alcohol intake. How does the presence or absence of comorbid conditions associated with alcohol consumption influence such conversations?Discuss the criteria for referring a patient with unhealthy alcohol use to a behavioral health provider.Invite a behavioral health clinician with expertise in unhealthy substance use to discuss local resources available to your patients.Test your learners' knowledge by having them complete the quiz that accompanies the article and then reviewing the correct answers.ProfessionalismGet Out the Vote: A Framework to Mobilize Medical Professionals to VoteMedical professionals, particularly physicians, nurses, and dentists, vote less often than the general U.S. population. By not voting, medical professionals are abstaining from matters that affect their patients and themselves. This commentary discusses strategies to mobilize physicians and other medical professionals to vote.Use this article to:Discuss the health-related issues in your state that have the potential to be affected by who wins the upcoming November election.Ask your learners if they are registered to vote, and ask those who are not why they have not registered.Review the procedures for registering in your locale.Are mail-in ballots an option? If not, develop a plan among your learners that would facilitate their ability to vote in this and future elections.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics October 2022Volume 175, Issue 10Page: ED10 ePublished: 18 October 2022 Issue Published: October 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...